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DOI: 10.1148/radiol.2491070783
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(Radiology 2008;249:16-31.)
© RSNA, 2008

Reviews

Management of the Incidental Renal Mass1

Stuart G. Silverman, MD, Gary M. Israel, MD, Brian R. Herts, MD, and Jerome P. Richie, MD

1 From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.G.S.), and Department of Urology (J.P.R.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Radiology, Yale University School of Medicine, New Haven, Conn (G.M.I.); and Department of Radiology, Cleveland Clinic, Cleveland, Ohio (B.R.H.). Received May 7, 2007; revision requested June 18; revision received August 28; accepted September 27; final version accepted October 22; final review by S.G.S. April 23, 2008. Address correspondence to S.G.S. (e-mail: sgsilverman{at}partners.org).

Despite substantial advances in the imaging-based diagnosis of renal masses, the increased detection of incidental renal masses with cross-sectional imaging poses problems to the radiologist and referring physician. Most incidental renal masses can be diagnosed with confidence and either ignored or treated without further testing. However, some renal masses, particularly small ones, remain indeterminate and require a management strategy that is both medically appropriate and practical. In this article, the literature will be reviewed and an approach to the diagnosis and management of the incidental renal mass will be suggested. Management recommendations, derived from data regarding the probability of malignancy in cystic and solid renal masses, are provided for two types of patients, those in the general population and those with limited life expectancy or co-morbidity. The Bosniak classification is used to guide the management of cystic masses, with observation reserved for selected patients, and the presumption of benignity recommended for simple-appearing cystic masses smaller than 1 cm. Among solid renal masses, a more aggressive overall approach is taken. However, additional imaging, and in selected patients, percutaneous biopsy, is recommended to diagnose benign neoplasms. Although additional studies are needed to establish risks and benefits, observation of solid masses may be considered in selected patients. Minimally invasive treatments of renal cancer (including percutaneous ablation) show promise but at the same time challenge the radiologist to review the approach to the incidental renal mass.

© RSNA, 2008




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